Obstructive Eustachian tube dysfunction is a common health problem affecting both children and adults. Balloon dilation of the Eustachian tube is an increasingly popular treatment for medically refractory obstructive Eustachian tube dysfunction and has widely been accepted in the treatment of adults. The procedure has traditionally been performed under general anesthesia. Performing balloon dilation under local anesthesia in an office setting provides advantages such as improved patient safety by avoiding the risks of general anesthesia, faster patient recovery and reduced treatment costs. The procedure itself is identical when performed under local anesthesia, but in order to accomplish a successful dilation there are certain details that have to be taken into account. We will describe a local anesthesia protocol and technique for safely and effectively performing balloon dilation of the Eustachian tube safely in an office setting.